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Value of screening for and treating pre-diabetes is reduced by low test accuracy and indirect evidence of impact on patient important outcomes
  1. Neri A Alvarez-Villalobos1,2,
  2. Rene Rodriguez-Gutierrez1,3,
  3. Victor M Montori1,4
  1. 1 Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota, USA
  2. 2 Department of Research Unit, University Hospital ‘Dr Jose E Gonzalez’ Autonomous University of Nuevo Leon, Rochester, Minnesota, USA
  3. 3 Division of Endocrinology, University Hospital ‘Dr Jose E Gonzalez’ Autonomous University of Nuevo Leon, Monterrey, Nuevo Leon, Mexico
  4. 4 Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, Minnesota, USA
  1. Correspondence to Dr Victor M Montori, Knowledge and Evaluation Research Unit and Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, 200 First Street SW, Rochester, MN 55902, USA; Montori.Victor{at}mayo.edu

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Commentary on: Barry E, Roberts S, Oke J, et al. Efficacy and effectiveness of screen and treat policies in prevention of type 2 diabetes: systematic review and meta-analysis of screening tests and interventions. BMJ 2017;356:i6538.

Context

Type 2 diabetes is a major cause of morbidity and mortality. Hoping to reduce the burden of diabetes on people and societies, guidelines have recommended screening for hyperglycaemia in healthy population.1 These recommendations assume that early detection and intervention can prevent the morbimortality associated with type 2 diabetes and its complications.1 The systematic review by Barry et al sought to evaluate the accuracy of screening and the efficacy of early intervention (lifestyle or metformin) to prevent type 2 diabetes1.

Methods

They conducted a rigorous systematic review of the published literature until June 2016. They then conducted two meta-analyses. The first one, a bivariate random-effects model meta-analysis, summarised …

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